Florida lawmakers considering health care changes

Saturday

TALLAHASSEE — Months after health care sharply divided Democratic and Republican candidates in last fall’s campaigns, Florida lawmakers are considering wide-ranging changes to what a GOP leader derides as the “hospital-industrial complex.”

Ideas on the table in Florida’s Republican-controlled Legislature steer clear of demands for universal health care or Medicaid expansion, advanced by federal and state Democratic contenders during the November elections.

Instead, House Speaker Jose Oliva, a Miami Republican, is pushing a host of regulatory changes to enhance competition in health care — which he said will drive down prices and eventually lead to more coverage in a state where 2.6 million people struggle with no insurance.

“Medicaid expansion is the worst of all Band-Aids,” Oliva said of the program now embraced by 37 states, including Republican-leaning Nebraska, Idaho and Utah, where voters in November approved expansion after state leaders refused.

Americans for Prosperity, the organization funded by the conservative Koch brothers, fought Medicaid expansion in those states, just as it did in Florida in 2015.

That year, Oliva joined other Republican House leaders who sided with then-Gov. Rick Scott in fending off a bid by fellow Republicans in the Senate to broaden Medicaid coverage for roughly one million lower-income Floridians.

The idea of expanding Medicaid coverage is basically dead in Florida, even though as a provision of the Affordable Care Act, dubbed Obamacare, a sizable majority of states now do provide coverage to people earning at or below 138 percent of poverty, or about $29,000-a-year for a family of three.

Almost all of that expanded coverage is paid for by the federal government.

During last fall’s campaign, Republican Gov. Ron DeSantis opposed expansion, which Democratic opponent Andrew Gillum advocated. And DeSantis’ lieutenant governor, Jeanette Nunez, was a House member who joined Oliva in opposing expansion during the 2015 session, when the fight with Senate Republicans continued into a special session of the Legislature.

Under Oliva this year, the House is advancing proposals aimed at relaxing regulations that have long guided health care.

Among them:

• Further reduce, and maybe eliminate, certificates of need required for hospitals, nursing homes and other facilities looking to expand.

But some experts cast doubt on whether Oliva’s health care changes would lower costs, even over decades, to a point where the uninsured could afford coverage.

Meanwhile, the number of Florida children without insurance climbed to 325,000 in 2017, a report last fall showed, the second highest in the nation.

“Health care is a different commodity from, let’s say, buying a car. It doesn’t really work the same way,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University.

“These proposals may have some merit,” she added. “But they’re not going to address Florida’s high uninsured rate.”

Although Oliva represents a Miami-Dade County district anchored in Hialeah, where one ZIP code includes the nation’s greatest concentration of residents enrolled in Obamacare, the speaker says government-supported health coverage is not the answer.

He blames rising costs on the current system, saying “one of the largest lobbies in the country are the hospital-industrial complex and Big Pharma.”

“You have to fix the environment to allow for competition,” Oliva said. “You have to prevent these monopolies that ... can charge private payers, insurance companies or health plans whatever they want.”

He added: “If you’re the only game in town, you don’t have to negotiate. You have to bring some real market forces into it.”

Americans for Prosperity is among those backing Oliva’s approach, arguing that more options will decrease costs and provide more health care access.

“Patients and health care providers should be in control, not politicians and broken policies,” said Skylar Zander, state director of the organization’s Florida chapter. “Increasing competition and eliminating government-run monopolies on health care can improve access to care for low-income communities and the rural parts of our state.”

But Oliva’s fellow Republican leader, Senate President Bill Galvano, of Bradenton, said he doubted whether proposed regulatory changes would do much to close the state’s large coverage gap.

Galvano backed Medicaid expansion in 2015, only to have it rejected by the House with the backing of Scott. He said expansion is now a “non-starter” in the Legislature.

Like Galvano, though, the Florida Hospital Association said it is open to hearing Oliva’s ideas. But FHA President Bruce Rueben said the way to lower cost is to change how health care is paid.

The traditional fee-for-service system is seen as contributing to rising costs. But if changes could be enacted that promote paying a set, bundled amount for a knee replacement, emergency visit or even child birth, costs could decline, Rueben said.

But even that major overhaul of the health delivery system won’t work if Florida continues to struggle with a massive population of uninsured, Rueben said.

“You can come up with the most effective way to pay for health care, a way that would encourage quality care at the lowest price,” Rueben said. “But if people aren’t covered, there’s no way for a new payment methodology to work."

“People are still coming in the emergency room when they’re really sick,” he added.

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